June 18, 2004

<**Moderator**> Hello and thank you for coming to tonight's chat with Dr. Simpson. Please enter your questions and they will be posted and answered in the order received. Thanks again for joining us.

<SHAWNNA> I am now on full liquids phase of post-op diet. Any suggestions on what to have ( other than jello?). Thank you

<Dr. Simpson> Full liquids --- sure, you need to see the list of full liquids which is on some website somewhere. Try yogurt-- flavored, but not the stuff with the fruit at the bottom, of course you can always try some soups. Healthy choice is a good choice and good brand. Sugar free popsicle, sustacal pudding. Lots of good stuff. So enjoy it. Good luck

<Patsy in Oklahoma> why do some people have drains and others do not?

<Dr. Simpson> Because when we remove the drains, and we get the stuff on our lab coats then we can say -- oh that is drain sauce, some like drains because if there is a leak it the drain is there and it is controlled. Where if you don't have a drain and develop a leak it can be harder to put one in, so some of us put them in and others do not-- it is individual choice. On some lap cases I put in a drain -- not lap band but the lap DS but when I remove the drain it doesn't hurt me a bit.

<Patsy in Oklahoma> How do you check for leaks post op and is it bad if a surgeon does not check for leaks before you leave the hospital?

<Dr. Simpson> There are a lot of ways to check for leaks, my favorite is to put the patient in a tub of water and see where the bubbles are. If you check a leak today does not mean that you will have a leak the following day and is no guarantee that you won't develop a leak a couple of days later, so checking for leaks means that at the time you don't have a leak, but it is easy to do. Often I check for them in the operating room, where I can put in a stitch. Sometimes I have the patient go to x ray for a second look later on and see how they are doing but it is neither good or bad to check for leaks.

<Patsy in Oklahoma> what does it mean to be a diplomat of the American Board of Surgeons? Is this the same as being board certified?

<Dr. Simpson> It is the same thing -- when you are board certified there are a lot of boards. The American Board of Surgeons is the one that you want to have and we are "diplomats" although that does not mean we should negotiate in the middle east. Also, a Fellow of The American College of Surgeons is a good thing to have. Finally, any surgeon who has a copy of my book is clearly someone who has passed the test of being a great surgeon and knowing how to take care of their patients.

<Patsy in Oklahoma> Will everyone have a nasogastric tube post op?

<Dr. Simpson> No many people will not place nasogastric tubes in patients. We might have them in during the operative phase, however, I remove them before the patient wakes up. Some surgeons do have ng tubes after surgery, but not all of them.

<jimohio470to278> Doctor Simpson, I just wanted to say thanks for a Great book. It took me two nights to read it. I am a slow reader. I am 10 months post-op, but would strongly recommend the book to pre-ops as well as post-ops.

<Dr. Simpson> Thanks mom, I told you not to come in the room.

<kathleen g> Dr. Simpson: I am four months open RNY post op and was recently Rx'd Prevacid for pain from sinuses to hips ... gastric reflux. After taking the meds for four days, the pain is gone. I intend to finish the 30 day supply of Prevacid. Will I have to continue to take the meds a long, long time? Does acid reflux go away in time? I never had this problem before surgery. Thanks.

<Dr. Simpson> Acid reflux is a complicated issue, but generally is worse the first month after surgery. The main reason is that people overfill their pouch -- which isn't a good thing to do. What I want my patients to do -- and all patients is to measure their food twice, eat once and vomit never. Then go take a walk after you eat, in fact take two.

<sunny> Is it true to help break a plateau you should take in more calories? I was told I should be taking in about 1,500 per day with my activity level, but I'm scared to take in that much, I've had no loss in 3 1/2 months.

<Dr. Simpson> I think that you should NOT take in more calories -- in fact to break the plateau I would suggest you: walk, walk , and then walk some more. Taking in more calories will only result in more calories being stored as fat, and that is not what you want to do. So, you need to make some changes in what you eat --- mild things to decrease the intake a bit, but mainly, walk.

<ELena> Is an MMPI really necessary for a psych evaluation, or will a session with a simple report do as well? If MMPI is necessary, why?

<Dr. Simpson> The mmpi is not necessary, it is an interesting test, however it is not necessary for the pre operative evaluation. In fact there is some controversy as to whether a psych evaluation is needed at all. There is no evidence that any psych eval can show if a patient will be compliant or not and a psych evaluation will not be revealing if someone will have problems after surgery. Further, there are plenty of people who operate on patients who have psychiatric illness, including me. I have operated on a lot of patients who have psychosis, neurosis, and halitosis.

<Patsy in Oklahoma> what determines the post op diet and why are there so many different versions?

<Dr. Simpson> All surgeons have different ideas, which change in time, and different reasons for what they do. I have found that in my office sometimes what I say and what my nutritionist says are a bit different and often she is correct but since I cut the check, she says that I am. There are a lot of reasons for different diets, the real thing that patients should do is not follow a formula, but instead we want you to learn about nutrition and to make a good choices, then you have the tools to last a lifetime instead of something for a short period of time. Plus it is a good thing to know what you are eating, and measure those amounts, so you can manage it. You cannot manage what you cannot measure.

<bks> Hi Doc, I was wandering now that I am 17 mths post op from rny, how many calories should I be consuming a day in order to get these last 10# off? I have slowed down considerably to about 2# a mth, I have lost though 160# so far and am very happy with at. Thanks for the response!

<Dr. Simpson> I think that you should plan on having a five hundred calorie per day difference in what you eat and what you expend. Which means you have to know how many calories a day you are using, which you can do if you use some devices that are on the market to measure things f or example www.healthwear.com has a device you wear on your arm and it will measure how many calories that you USE per day, then you input what you eat and you will find out how you are doing. If your differential is about 500 calories a day then you will lose the weight over the course of time in an easy manner. Of course, it is never easy -- but without knowing how many calories you are using it is impossible to tell you how many calories to eat. You can also get a pedometer from some sports shop and plan on 10,000 steps per day, keep walking and keep losing.

<Anthony> what is mmpi?

<Dr. Simpson> Minnesota Multi phasic inventory test --- or personality test. It is something that the shrinks use to measure our inner psyche and can give some information but it is not always useful.

<janet> I'm considering the surgery. When filling out the questionnaire, what if I can't remember all the dates of attempted weight loss and past weights of prior years?

<Dr. Simpson> Well then you will have to give up entirely and that is it. I think what we want is not an exact date, what we really want are some approximations in order that we might gauge that you have made some real attempts that they have lasted for more than a week or two and that you have made progress. I think that you need to be able to lose weight, because if you CAN NEVER lose weight then there is something wrong -- like you are lying to us or that you are just a bit weird. So we won't ask for exact dates, but give them as close as you can-- for example, if you were on Atkins for six months and lost 50 pounds 0 it really doesn't matter if it was between May and December or between some other dates. Just give us a general idea. If you were on a diet plan for a week, well, that isn't really a diet plan, that is a phase. Your longest diet should last as long as one of my marriages. Good luck.

<al> do you lose hunger pains after gastric bypass

<Dr. Simpson> No hunger pains are sometimes not lost, and often not lost. Hunger is often felt in the head, not the gut, and you will still feel them, although they might be satisfied a bit better. Much like, you can have a leg cut off and still feel foot pain in that amputated limb,which is something that is strange, but true -- and hunger can be in the head, one thing that patients will notice however is that you will be satisfied easier, and that you may not be hungry for a while.

<cece> How do I find more information on participating in a clinical study?

<Dr. Simpson> Clinical studies are things which are done by specific institutions for situations and how you become involved in one is to find a surgeon who is doing a study and go from there. I am thinking of doing a study about patients giving me money. You may enroll.

<Carrie> I am overweight but I have no current health problems am I still a candidate?

<Dr. Simpson> You can be a candidate for surgery if your BMI is 40, you can be a candidate for President if you were born in this country, are at least 35 years old and you are stupid.

<lisa> I'm 27 years and at 290 pounds and have been on many home diets that have failed for years..i have been to doctors and they would never put me on medication i was always handed the food chart and sent on my way..I am a borderline diabetic and have high blood pressure ...would i qualify at all for surgery?

<Dr. Simpson> Well, unless you are seven foot tall, which can always happen Yes you would qualify for surgery, whether your insurance company will pay for the surgery is another matter. Some insurance companies want you to be on a physician supervised diet, which is more than a good chart -- although food charts are fine. There is a lot of diet plans out there, but they want some specific things, there are some great templates for physicians around to use. Like in the appendix of the book listed above. But many physicians do not know what a supervised diet is, so often I will have them place patients on a specific diet and have them meet with the doctor once a month. Weigh in twice a month, and meet with a nutritionist and a physical therapist and of course, you should always start a good program for walking.

<mimi> Is there a protein powder that is superior to others?

<Dr. Simpson> steak not powdered, chewed. Protein powder is essentially sawdust and in terms of it, there are some which are more bioavailable than others. For example, whey protein is a good source of protein, and better than soy protein.

<Jan> what is your opinion of lap RNY vs. open RNY?

<Doctor Simpson> They both work well, they are the same operation through different approaches and it depends upon which one that your surgeon does, as opposed to what you might like. I think that you will find that whatever your surgeon wants to do, that is what you should do.

<carolyn> How come the lap band procedure isn't recommended more often?

<Doctor Simpson> It is new and so it is something that isn't that well known to a lot of surgeons. I happen to think that it is a great procedure, which is one that we should be doing more, it is the most common procedure done in Europe and in Australia and the results that are coming out now are every bit as good, if not better, than the RNY. So I would predict that this will be the procedure of choice in a few years and you can take that to the bank. There will also be more bands available in a few years.

<Virginia Foster> what is a leak and how dangerous are they if at all? Is that two questions :)

<Doctor Simpson> A leak is where some of the contents of the gut spill out and it is quite dangerous and can lead to a lot of very bad things. I think that we keep an eye out for them, pretty much you are about of danger after the first week, although strange things can happen. So, don't leak.

<StayPuffMan preop> What does proximal/distal mean?

<Doctor Simpson> A proximal bypass is a bypass where about 15 per cent of the intestine is bypassed, and a distal is defined by insurance companies as more than 100 cm of bowel are bypassed, although we consider it distal when more than 50 per cent is bypassed and there is a lot of stuff in the middle. Guts is guts

<cali-pre-op> the dr. i am using is new to my area and has formed a new group here which my insurance contracts through, i have recently found out that she has had 2 major leaks in the last 50 surgeries she has performed should i be worried?

<Doctor Simpson> No I don't think you should be worried -- because leak rate is 1 to 3 per cent and that is within that leak rate and she could have had a run of bad luck, those things happen -- and conversely she could have 500 patients without a leak, which makes you think everything is wonderful. I think that you have to simply recognize that leaks happen and that you want to do the best you can to not get one-- which is by doing things like getting up and walking a lot after surgery. Do not overfill your pouch, and do not eat when nauseated. Good luck.

<kathleen g> Dr. Simpson: Pre-op it was determined I am "pear shaped." A super-sized J.Lo without the money or talent. In the weight loss journey, will weight come off more slowly from a "pear" or an "apple"? Thanks.

<Doctor Simpson> All I know is that if I had J lo on me she would not come off easily. Oh, wrong question. There is no real good research into whether an apple or a pear will be better or worse, but it makes for some great conversations. However, I prefer to talk about J Lo myself.

<sherry b.> which surgery is best the RNY or DS?

<Doctor Simpson> The surgery that is best for you is the one that your surgeon recommends and the one that he/she does a lot That is the best surgery for you.

<Anthony> I weigh so much now that I have tried ton start walking, i am pre-op, but I can't walk for more then 1/2 a mile and then my back and legs hurt so for 3 days i can just about get around. Ids this a good thing to continue?

<Doctor Simpson> I think that you should see a physical therapist and begin a program with them and I think you should find a good pool to go to and begin some water aerobics there and while you are at the pool would you mind bringing me one of those little drinks with an umbrella?

<Kingfish> Doc, what is the most important thing I should ask my doctor during our consultation?

<Doctor Simpson> You need to have an understanding of the surgery that they are going to be doing to you. You are going to have to have an understanding of what your expectations are and what they have for support for those goals and you have to know what you can expect if you do the maximum and nothing at all. Then if you have any questions about how they do things, or why they select one surgery over another. That is a good question to ask them. You want to know where you will have the surgery and you have to feel comfortable that this surgeon will be there for you as opposed to someone who has a sense of humor like me.

<christy> dr. simpson i have seen alot of chat by doctor i think you are the best and i enjoy you the most

<jelly> is it unrealistic to think I could be back to work in 3 weeks with lap rny?

<Doctor Simpson> It is not unreasonable to think that at all. My nurse had a lap band on a Tuesday and was back to work the following Monday, I wonder why it took her so long but if something goes wrong with the surgery, or there is a complication, you can expect that the recovery will be longer than that. So while you can plan on three weeks, you should also consider that it might be longer, and make certain you have some disability insurance in place if your work does not have it. Good luck.

<Peggy C> how do you feel about people going out of the country for the surgery

<Doctor Simpson> I don't even like taking patients from out of state into my practice. Going out of the country is a difficult thing to do for a number of reasons. First the medical facilities in the US are second to none, and if you have a heart attack somewhere else, you will wish you were here. Plus you want to have surgery where you can have and take advantage of the aftercare, if you think surgery is just about an operation and then off you go---- then you have an unrealistic view of what it is all about. There are many fine surgeons outside of the US, and I know them, and like them and trust them, and they can operate on me at anytime. However, if my family needs this operation I will have them have it here in the US because if they need other support-- there is no better place than here.

<Cindy Bailey> will you do wls on a person that is depressed, compulsive, with D.I.D, ?

<Doctor Simpson> I don't know what DID is -- or who did it but depressed -- no problem, compulsive -- great. I have even operated on people with schizophrenia.

<Cynthia> I have had Roux en Y surgery- My appetite has expanded.I am afraid of gaining weight. Help...

<Doctor Simpson> you need to do several things: first measure what you are eating and I think that you should see what you should eat and measure it. Start walking more, and eat low glycemic index foods.

<Beth> I just got home from the hospital after having open incision gastric bypass, I noticed that my calves have swollen up. What does that mean?

<Doctor Simpson> It is difficult to understand what that means -- it could be simple as you have some excess fluid or it could mean that you have a blood clot, and it is hard to imagine what it is without examining you. So put your calf up in the USB outlet and let me analyze it.

<dw> I am post op and have problems with acid reflux....is this a normal

<Doctor Simpson> Acid reflux is not normal, but I do think that it needs to be treated, so get some treatment for it and get it evaluated.

<Shawn Cloud> Is it common for a patient to back out of surgery?

<Doctor Simpson> Not common -- in fact, most of the time they can't wait to get it done and instead of backing out they have to wait too long but if they back out - that is just fine, better to back out and re consider than to think that you will be forced into it.

<bubba> how can i know if I have a blood clot? What are warning signs?

<Doctor Simpson> Often times they are silent, and you cannot tell that they are there. The only way that you can tell is to have an Doppler ultrasound examination of the legs to see if there is one.

<Dave Land> Is it easier for the surgeon to use the open technique rather than the laproscopic procedure?

<Doctor Simpson> Actually I think that laparoscopic surgery is easier to see things than open, and I prefer it for a lot of cases but many surgeons do not have the training in laparoscopic surgery , and for them open is better.

<hellohello> I AM 3 YEARS POST OP AND I FIND MYSELF EATING MORE AND MORE CAN I GET A GRIP ON THIS AND START LOSING AGAIN WND GO BACK TO THE WAS IT WAS ?? PLEASE HELP

<Doctor Simpson> Well, in terms of eating more you need to do a few things about that and I think that what you want is to begin to measure what you are eating

<vonnie> Hi Dr Simpson....I found out I have a staple line disruption and been having pain and vomiting for the past 2 months. Other then weight gain is there any other complications that can arise prior to getting it repaired?

<Doctor Simpson> In terms of pain and vomiting, You need to have that evaluated by a surgeon and perhaps a gastroenterologist.

<Doctor Simpson> For the rest of you who have questions --- really, the book is pretty good at answering those as well as these, it is 390 pages. www.obesitydr.com Thank you all for your time and interest. I am off to catch a fish, salmon I hope. Good night

<**Moderator**>Thank you all for joining us this evening. To learn more about Dr. Simpson, please visit his website. http://www.drsimpson.com/, or call 602-234-8998 to schedule a consult. You can get his book at www.obesitydr.com.